Citation NR: 9621026
Decision Date: 07/31/96 Archive Date: 08/06/96
DOCKET NO. 94-04 739 ) DATE
)
)
On appeal from the
Department of Veterans Affairs Regional Office in New York,
New York
THE ISSUE
Entitlement to service connection for residuals of a
cerebrovascular accident.
REPRESENTATION
Appellant represented by: American Red Cross
ATTORNEY FOR THE BOARD
R. E. Smith, Counsel
INTRODUCTION
The veteran had active military service from November 1942 to
December 1943.
This matter came before the Board of Veteransí Appeals
(Board) on appeal from a June 1993 rating action of the
Department of Veterans Affairs (VA) New York, New York,
Regional Office (RO), which denied the veteran entitlement to
service connection for residuals of a stroke.
REMAND
In this case, the veteran contends that he is entitled to
service connection for residuals of a March 1992
cerebrovascular accident which he maintains was caused by his
service-connected rheumatic heart disease.
Our preliminary review of the veteranís claims file shows
that the veteran was hospitalized at the Bronx, New York, VA
Medical Center in March 1992 following the onset of right-
sided numbness and slurry speech. The veteran was evaluated
and medicated with Ectorin, and his numbness and dysarthria
were recorded to have resolved fully. He was then reported
to have been started on Procardia with good results. A
carotid Doppler study during this hospitalization was
positive for plaques, and it was indicated by his treating
physician that his cerebrovascular accident was most likely a
transient ischemic event involving the left cerebral
hemisphere. The veteran was discharged approximately 10 days
after his admission in reportedly good condition.
VA clinical data on file prior to the veteranís March 1992
stroke shows that on a VA examination in April 1989, the
veteran was found to have no jugular vein distention and no
bruits. Blood pressure at that time was, however, noted to
be 200/120 and poorly controlled. Hypertension was
diagnosed. A May 1989 echocardiogram found no evidence of
valvular heart disease. On his most recent VA examination in
May 1993, the veteran reported that his March 1992 stroke was
characterized by a twisting of his face to the left and very
little use of his left hand. It was further recorded that
these symptoms and findings had apparently cleared within two
weeks. On examination on this occasion, the veteran
demonstrated no motor or sensory impairment, and there was no
functional impairment of the peripheral nervous system or
autonomic nervous system.
It was noted on the May 1993 VA examination that an earlier
March 1992 computer tomography scan of the veteranís brain
had revealed mild generalized cerebral atrophy and increased
periventricular white matter lesions, more marked on the left
than on the right. There was also a supracella density which
was subsequently investigated and thought to be an anterior
communicating artery aneurysm. Doppler studies of the
arteries in the neck reportedly revealed some plaque in both
common carotid arteries. The interrelationship between the
findings on the May 1993 VA examination, the veteranís
service-connected rheumatic heart disease and his March 1992
cerebrovascular accident were not clearly indicated or
otherwise commented upon by the examiner. Consequently, the
Board is without any medical clarification as to whether the
veteran suffers from current residuals of a March 1992
cerebrovascular accident and, furthermore, whether this
cerebrovascular accident, itself, was etiologically related
in any way to the veteranís service-connected heart disease
as the veteran contends.
The Board is not permitted to exercise its own unsupported
and independent medical judgment to resolve such medical
questions as are presented by this claim. Colvin v.
Derwinski, 1 Vet.App. 171 (1991). Moreover, a decision by
the Court has called into question the legal authority of the
Board to utilize medical opinions obtained from its own staff
medical advisers. Austin v. Brown, 6 Vet.App. 547 (1994).
Therefore, the primary source of this essential evidence
remains the medical staff of VA medical centers;
necessitating a remand of this case.
Accordingly, this appeal is hereby REMANDED to the RO for the
following actions:
1. The veteranís claims folder and the
associated VA medical records, together
with a complete copy of this REMAND
decision, should be referred to a VA
staff cardiologist and staff neurologist
for review in connection with a complete
cardiovascular and neurological
examination of the veteran. The purpose
of these examinations is to ascertain the
current residual disability, if any,
associated with his March 1992 stroke and
the etiology of that event. With regard
to the etiology of the veteranís March
1992 stroke, the veteranís cardiovascular
examiner should indicate, if not directly
involved, whether the veteranís rheumatic
heart disease contributed to the
underlying conditions leading to the
stroke. The examiner(s) should respond
to the following questions providing a
complete rationale for all conclusions
reached:
a. Are there any currently
identifiable residual disabilities
resulting from the veteranís March
1992 cerebrovascular accident?
b. What is the likelihood that the
veteranís March 1992 cerebrovascular
accident was caused by his service-
connected heart disease either
directly or indirectly?
Specifically, the examiner(s) must
determine if there is any current
residual disability from the
veteranís March 1992 stroke and, if
so, the likelihood that such
disability was due, in any way, to
the veteranís service-connected
heart disease.
2. The RO should readjudicate the
veteranís claim. In so doing, it should
specifically consider the provisions of
38 C.F.R. ß 3.310(a) and the directives
set forth in Allen v. Brown, 7 Vet.App.
439 (1995) regarding aggravation. If the
determinations remain adverse to the
veteran, he and his representative should
be provided a supplemental statement of
the case which includes a summary of the
additional evidence, any additional
applicable laws and regulations and the
reasons for the decision. The veteran
and his representative should be afforded
the applicable time to respond.
The case should then be returned to the Board for further
appellate review. The purpose of this REMAND is to obtain
additional evidence and ensure that the veteran is afforded
all due process of law. The Board intimates no opinion,
either factual or legal, as to the ultimate conclusion
warranted in this case.
EUGENE A. OíNEILL
Member, Board of Veterans' Appeals
The Board of Veterans' Appeals Administrative Procedures
Improvement Act, Pub. L. No. 103-271, ß 6, 108 Stat. 740, 741
(1994), permits a proceeding instituted before the Board to
be assigned to an individual member of the Board for a
determination. This proceeding has been assigned to an
individual member of the Board.
Under 38 U.S.C.A. ß 7252 (West 1991), only a decision of the
Board of Veterans' Appeals is appealable to the United States
Court of Veterans Appeals. This remand is in the nature of a
preliminary order and does not constitute a decision of the
Board on the merits of your appeal. 38 C.F.R. ß 20.1100(b)
(1995).
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